@article{Christe:2937,
      recid = {2937},
      author = {Christe, Guillaume and Hall, Toby},
      title = {The screening process of a patient with low back pain and  suspected thoracic myelopathy : a case report},
      journal = {Journal of Manual  Manipulative Therapy},
      address = {2018-01},
      number = {ARTICLE},
      pages = {7 p.},
      abstract = {Background: 
Thoracic disc herniations are rare and  difficult to diagnose. Myelopathy is a potential  consequence that can lead to irreversible neurological  impairment if not treated appropriately. It is incumbent on  all clinicians who see patients with low back pain (LBP) to  be aware of such pathologies. This case describes a  screening process in the detection of a rare serious spinal  pathology and discusses the use of red flags and central  nervous system signs and symptoms in the decision leading  to immediate referral.
Case Description:
The subject in  this case was a 69-year-old male referred to physical  therapy for the treatment of LBP after having seen two  medical doctors. He presented with severe spinal pain with  gait disturbance, postural balance deficits and bilateral  loss of plantar flexor strength. Decreased sensation in the  buttocks and a subtle episode of urinary incontinence were  also present.
Outcomes:
Based on the results of the history  and physical examination, the patient was referred back to  his medical practitioner, who ordered magnetic resonance  imaging. A thoracic disc herniation associated with  spondyloarthritis at T10–11 causing myelopathy was  detected, and the patient underwent immediate decompressive  surgery. One month following initial evaluation, the  patient had completely recovered without any neurological  compromise.
Discussion: 
This case highlights the  importance of the screening of serious pathologies and the  assessment of central nervous impairments in certain cases  of LBP. The integration of a cluster of subjective and  physical examination findings led to the prompt referral of  this patient for urgent medical attention.
Level of  Evidence: 4.},
      url = {http://arodes.hes-so.ch/record/2937},
      doi = {https://doi.org/10.1080/10669817.2017.1282189},
}